Does prophylactic treatment of patent ductus arteriosus affect utilization of hospital resources?

Abstract

Introduction: Patent ductus arteriosus (PDA) and its treatment are associated with multiple serious complications in very low birth weight (VLBW) infants. Methods: We retrospectively evaluated the effect of prophylactic PDA treatment with Indomethacin on markers of utilization of hospital resources in a regional neonatal intensive care unit (NICU) between January 1, 2005 and April 30, 2007, including a six month epoch when PDA prophylactic treatment with indomethacin was used in the study site. Infants with gestational ages less than 28 weeks who survived for more than two days were included in the analysis. Results: Twenty infants received Indomethacin prophylactic treatment (treatment group) and 59 received no prophylactic treatment (control group). Infants in the treatment group had similar median gestational age; 26 weeks, but higher birth weights (mean ± SD); 964 ± 247 vs 838 ± 198 grams, p = 0.043 compared to control infants. Prophylactically treated infants needed rescue PDA pharmacologic treatment less frequently (20% vs 63%, p = 0.002) but had similar rates of surgical ligation (30% vs 29%) compared to control infants. Prophylactically treated infants also had significantly higher rates of intestinal perforation (25% vs 7%, p = 0.041) and abdominal surgeries (30% vs 8%, p = 0.03) compared to control infants. The two groups had similar, duration of support with mechanical ventilation and similar duration of supplement with parenteral nutrition. Treatment and control infants had similar rate of survival to discharge to home, 17 (85%) vs 45 (76%). Surviving treated and control infants did not differ statistically in total observed hospital length of stay (LOS in days, mean ± SD); (96 ± 32 vs 89 ± 29; p = 0.43) nor in the difference between observed and predicted LOS (mean observed- predicted ± SD) (10 ±23 vs1 ± 23; p = 0.14). Conclusions: Prophylactic PDA treatment with Indomethacin did not decrease duration of mechanical ventilation or TPN supplementation but was associated with more intestinal perforations and abdominal surgeries. The unfavorable trend in LOS for the treatment group implies that the independent effect of prophylactic PDA treatment on LOS needs to be further explored.